The effect of prophylactic surgery in survival and HRQoL in appendiceal NEN
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ORIGINAL ARTICLE
The effect of prophylactic surgery in survival and HRQoL in appendiceal NEN Krystallenia I. Alexandraki1 Gregory Kaltsas1 Simona Grozinsky-Glasberg2 Kira Oleinikov2 Beata Kos-Kudła3 Angelika Kogut3 Rajaventhan Srirajaskanthan4,5 Michail Pizanias6 Kalliopi-Anna Poulia7 Clara Ferreira8 Martin O. Weickert9,10,11 Kosmas Daskalakis 1,12 ●
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Received: 26 March 2020 / Accepted: 15 May 2020 © The Author(s) 2020
Abstract Background/aims Long-term outcomes are understudied in patients with well-differentiated appendiceal neuroendocrine neoplasms (WD-ANENs). We aimed to evaluate the validity of currently applied criteria for completion prophylactic right hemicolectomy (pRHC) and determine its association with patient outcomes, including health-related quality of life (HRQoL). Methods Eligible patients from five European referral centers were divided between those who underwent appendectomy alone and those who underwent completion pRHC. HRQoL EORTC-QLC-C30 questionnaires and cross-sectional imaging data were prospectively collected. Age- and sex-matched healthy controls were recruited for HRQoL analysis’ validation. Results We included 166 patients (119 women [71.2%]: mean age at baseline: 31 ± 16 years). Mean follow-up was 50.9 ± 54 months. Most patients (152 [92%]) had tumors ≤20 mm in size. Fifty-eight patients (34.9%) underwent pRHC that in final analysis was regarded as an overtreatment in 38/58 (65.5%). In multivariable analysis, tumor size >20 mm was the only independent predictor for lymph node (LN) involvement (p = 0.002). No mortality was reported, whereas 2-, 5- and 10-year recurrence-free survival in patients subjected to postoperative cross-sectional imaging (n = 136) was 98.5%, 97.8%, and 97.8%, respectively. Global HRQoL was not significantly impaired in patients with WD-ANEN compared with age- and sex-matched healthy individuals (median scores 0.83[0.08−1] vs 0.83[0.4−1], respectively; p = 0.929). Among patients with WD-ANEN impaired social functioning (p = 0.016), diarrhea (p = 0.003) and financial difficulties (0.024) were more frequently reported in the pRHC group. Conclusions WD-ANEN is a low-malignant neoplasm with unconfirmed associated mortality, low recurrence rate, and overall preserved HRQoL. pRHC comes at a price of excessive surgery, functional HRQoL issues, and diarrhea. The value per se of a prophylactic surgical approach to patients with WD-ANENs 10 years. As part of the study, participants were also asked to fill in a HRQOL EORTC-QLQ-C30 questionnaire [14]. HRQOL questionnaires were also obtained from 20 healthy control cases of age- and sex-matched individuals who did not have any abdominal surgery in their personal history, for comparison. The study was conducted according to the 1975 Declaration of Helsinki and approved by the pertinent Human Research Ethics Committee of each institution. In the collaborating centers from UK, the study was officially registered as an audit. Written informed consent for the study was obt
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